1851624704 NPI number — MR. EUGENE JOSEPH CRISAFULLI PHARMACIST

Table of content: MR. EUGENE JOSEPH CRISAFULLI PHARMACIST (NPI 1851624704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851624704 NPI number — MR. EUGENE JOSEPH CRISAFULLI PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRISAFULLI
Provider First Name:
EUGENE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851624704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYS TOWN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68010-0103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-216-4055
Provider Business Mailing Address Fax Number:
402-919-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15519JACKSON CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-216-4055
Provider Business Practice Location Address Fax Number:
402-919-9030
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  10464 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com